About ED | Expert opinion | Understand Erectile Dysfunction

What are the main causes of ED?

It can be difficult to talk about Erectile Dysfunction (ED), but ED is more common than you think. There’s a good chance that the guy sitting next to you might have ED, or that the woman across the room is wondering how to help her partner find answers. Understand the causes of ED in this article. 

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Expert Opinion – What are the most common causes of ED?

Expert Opinion from David Ralph Andrologist

What Is Erectile Dysfunction (ED)?

Erectile dysfunction is when a man either can not achieve an erection or can not keep an erection long enough to have sex. Your ED may have a physical cause. Over 80% of men suffering from ED can trace its origin back to a problem or disorder1 When the causes of your ED is due to a physical condition, your ED is not a reflection on you or your sexual partner, since lack of arousal is not usually the problem.

Physical causes of ED

  • An injury (for example brain injury, spinal cord injury, penile injury)
  • A disease (for example diabetes, high blood pressure, high cholesterol, cardiovascular disease or Peyronie’s disease)
  • An operation (for example prostate removal)
  • Substance use (for example drugs, alcohol or some medications)

Conditions that can cause ED

ED can be caused by one of several medical conditions that reduce blood flow and nerve functioning. If a medical problem is causing your ED, it means there are treatment options.


Diabetes can cause nerve, blood vessel, and muscle damage that results in problems like pain, numbing or loss of sensation in the hands and feet2.These issues can also result in ED problems, because nerve signals and blood flow are a necessary part of the process in getting an erection3. Also as men with diabetes become older, ED problems can become more common4.

Finding the right treatment option

Most causes of ED can be treated, and oral medications are often the first step. However, they have been shown to be less effective for men with diabetes, and more advanced treatment options may be needed5 In those cases, ED treatment options such as injection therapy, vacuum devices, or a penile implant may be recommended6.

If you are a diabetic and experiencing ED, talk with your doctor or diabetes nurse specialist about the treatment options that may be best for you. They may refer you to a Urologist or a nurse specialist who have specialised in treating men with ED. Learn more on the link between “Diabetes and ED“in our article.

Heart Disease

Did you know that erectile dysfunction precedes coronary artery disease in almost 70 percent of cases?

ED can be an early warning sign of heart problems7

A buildup of plaque inside the arteries can limit the amount of blood that is able to flow through them with coronary artery disease. If the flow of oxygen-rich blood to your heart muscle is reduced or blocked by this hardening of the arteries, the result can be angina (chest pain) or a heart attack8. Because the arteries that supply blood to the penis are much smaller than the ones that feed the heart, the problem may show up earlier as having difficulty getting an erection.9

ED is common among patients with cardiovascular diseases (CVD). Sexual problems usually precede the onset of CVD, and should, therefore, be considered as a risk factor for cardiac events. Similarly, patients with preexisting CVD are at increased risk of experiencing ED. Therefore, ED and CVD might be considered as two clinical manifestations of the same systemic disease.7


What does it mean for you?

If you are experiencing ED, you should talk with your doctor about your potential risk for cardiovascular disease. And, if you’re already taking certain medications such as nitrates for your heart or alpha-blockers to manage blood pressure, your doctor will discuss whether ED medications are right for you or whether other options may be more appropriate. Learn more about ED & Cardiovascular disease in our article.

Prostate Cancer

Prostate cancer10is not considered a cause of ED. Due to potential treatment for prostate cancer, for example radiation treatments, hormone therapy, and surgery to remove the entire prostate gland,  the development of a difficulty in getting or keeping an erection may occur. Sometimes, erectile dysfunction related to prostate cancer treatment is only temporary, but there are many men who experience ongoing difficulties, that need to be addressed by other means.

Your ability to orgasm is not connected to the prostate gland, although a man who has had a radical prostatectomy, will have a dry orgasm with no ejaculation. As long as you have normal skin sensation, you should be able to have an orgasm with the right sexual stimulation. This means that treating your ED should allow you to resume a normal, healthy sex life.

Neurological Problems

11 Parkinson’s, Alzheimer’s, and MS (multiple sclerosis) can lead to ED because they all interfere with the brain’s ability to communicate the sexual desire to the reproductive system.

Talk to your doctor or nurse to understand the causes. The proper treatment can be recommended to help you return to a satisfying life.

Untreated ED can damage your self–confidence, causing a lot of stress— even depression and anxiety. Many guys with ED feel like their lives are out of their control. The good news is there’s hope.

Take back control. Use our Specialist Finder tool to locate a doctor in your area who can provide information on how to best treat your ED.

Watch our Expert’s testimonials videos for more advice

1: Khera M, Goldstein I. Erectile dysfunction. BMJ Clin Evid. 2011 Jun 29;2011. pii: 1803. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3217797/http://www.clinicalevidence.com

2: Diabetic Neuropathy. https://www.mayoclinic.org/diseasesconditions/diabetic-neuropathy/symptoms-causes/syc-20371580 Accessed 2/2/18

3: Erectile dysfunction. NIH: National Institute of Diabetes and Digestive and Kidney Diseases. http://www.nlm.nih.gov/medlineplus/erectiledysfunction.html. Accessed June 2017.

4: Sexual and Urologic Problems of Diabetes. NIH: National Institute of Diabetes and Digestive and Kidney Diseases. http://diabetes.niddk.nih.gov/dm/pubs/sup/. Accessed May 2015

5: Walsh TJ, Hotaling JM, Smith A, Saigal C, Wessells H. Men with diabetes may require more aggressive treatment for ED. Int J of Impotence Research 2013; 26:112-115

6: Erectile dysfunction. NIH: National Institute of Diabetes and Digestive and Kidney Diseases. http://www.nlm.nih.gov/medlineplus/erectiledysfunction.html. Accessed June 2017.

7: Gandaglia G, Briganti A, Jackson G et al. A systematic review of the association between erectile dysfunction and cardiovascular disease. Eur Urol. 2014 (65):968-978.

8: What is Coronary Heart Disease? (n.d.) Retrieved from https://www.nhlbi.nih.gov/health/health-topics/topics/cad

9: Thompson IM, Tangen CM, Goodman PJ et al. Erectile dysfunction and subsequent cardiovascular disease. JAMA 2005; 294(23):2996-3002.

7: Gandaglia G, Montorsi F, Montorsi P. Management of erectile dysfunction in patients with preexisting cardiovascular disease. GItal Cardiol (Rome). 2016 May;17(5):356-62.

10: CHAMBERS 2016 TAU Erectile dysfunction, masculinity, and psychosocial outcomes, a review of the experiences of men after prostate cancer treatment

11: https://www.webmd.com/erectile-dysfunction/guide/understanding-ed-causes#1)


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